Beers标准和STOPP/START标准对老年住院患者潜在不适当用药的评价

Evaluation of potential inappropriate medication in hospitalized elderly patients based on Beers and STOPP/START criteria

目的评估解放军总医院第二医学中心老年住院患者潜在不适当用药(potential inappropriate medication,PIM)的发生率,考察2种PIM标准的适用性,分析PIM的影响因素。方法对解放军总医院第二医学中心2017年5月-2018年10月老年住院患者进行问卷调查,筛选年龄≥65岁、长期用药≥4种且问卷信息较为完整的患者进行分析。结果共纳入398例老年患者,平均年龄为87.17±8.45岁,平均患慢性疾病种类数6.38±2.17。依据Beers标准,288例存在潜在不适当用药,共834项;依据STOPP标准,194例存在潜在不适当用药,共318项;依据START标准,155例存在处方遗漏,共195项。两筛选标准对解放军总医院第二医学中心老年患者用药分析时一致性较差(Kappa=0.255,P <0.001)。Logistic回归结果分析显示,住院时间、有无失眠症状是两种标准筛选PIM发生的共同危险因素;此外,经Beers筛选还发现房颤,长期用药种类数也是PIM发生的危险因素,经STOPP/START筛选发现患者高龄状态、有无高血压均会影响住院患者的PIM。结论 Beers和STOPP/START在评估老年住院患者潜在不适当用药方面具有重要的参考价值。患者住院时间长、有失眠症状均是PIM发生的危险因素。患有慢性房颤、高血压的老年患者相较于其他疾病状态患者PIM发生率较高。老年住院患者使用Beers标准具有更高的PIM检出率。

Objective To investigate the incidence of potential inappropriate medication(PIM)among hospitalized elderly patients in the Second Medical Center using Beers and STOPP/START criteria,and analyze the main inuencing factors of PIM.Methods A cross-sectional study was conducted in elderly patients hospitalized in the Second Medical Center of our hospital from June 2017 to October 2018 and the complete data of patients aged 65 years or older who used 4 or more types of chronic medications were selected and analyzed.Results A total of 398 elderly patients with mean age of(87.17±8.45)years and(6.38±2.17)chronic diseases were included in the study.The Beers criterion identied 834 PIMs in 288(73.26%)patients.According to the STOPP/START criterion,194 patients had 318 PIMs.The STOPP/START criterion identied 195 prescription omissions in 155 patients.The two criteria showed significant inconsistency in the analysis of PIMs in elderly inpatients(Kappa=0.255,P<0.001).Logistic regression analysis showed that the length of hospital stay and the symptom of insomnia were risk factors for PIM.Besides,atrial brillation and the number of chronic medications were risk factors for PIM identied by Beers criterion,and advanced age and hypertension were risk factors for PIM identied by STOPP/START criterion.Conclusion Beers and STOPP/START criteria are useful tools in assessing PIM in elderly hospitalized patients.The length of hospital stay and the symptom of insomnia are risk factors for PIM.Older patients with atrial brillation or hypertension may have a higher incidence of PIM than those with other disease states.In our hospital,Beers criterion has a higher PIM detection rate in elderly hospitalized patients.